Reply to these post with 300-350 words for EACH post.

Post 1 

What lifestyle modifications do you recommend for CF?

    The lifestyle modifications that I would recommend for CF would include losing weight if he is overweight, raising the head of bed at night by adding pillows so his head is above his heart/stomach which can prevent acid from rising and will decrease the nighttime heart burn, avoiding eating late at night, avoiding large meals, to not lay down immediately after a meal, wearing loose comfortable clothing, and although he states he does not smoke anymore I would reiterate quitting smoking (Kahrilas, 2021). Other recommendations that I would make are specifically related to avoiding triggering foods. Triggering foods for heartburn and causing GERD flares are caffeine, chocolate, peppermint, spicy foods, and some fatty foods (Kahrilas, 2021). I would also encourage CF to keep a food journal which would allow him to pinpoint foods that bother him specifically.

Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.

    The rational drug choice for this patient would be a proton pump inhibitor (PPI). I would prescribe this because CF has already tried an H2 receptor antagonist and antacids with no relief so a PPI would be the next first line choice (Woo et al., 2020). Kahrilas (2020), states that PPI’s are the most effective medications for reducing stomach acid and H2 receptor antagonists can reduce stomach acid but are not usually effective in moderate to severe symptoms. PPI’s work by reducing gastric acid secretion in the stomach by blocking the mechanism of action of parietal cells (Woo et al., 2020). Parietal cells are cells found in the stomach wall and their role is to secrete acid. Gastric acid secretion is reduced by inhibiting the H+/K+/adenosine triphosphatase (ATPase) enzyme system found in the parietal cell (Woo et at., 2020). CF is appropriate for a PPI as it is approved for adults, he is male so there is no pregnancy risk as it is category B/C, and he is 48 so there is no concern for the use of it in an older adult (Woo et al., 2020). Before I started CF on a PPI I would run a liver panel and make sure that CF’s liver function was normal as PPI’s are metabolized in the liver and are contraindicated in patients with hepatic dysfunction (Woo et al., 2020). Hicklin (2017) found that blocking stomach acid can add to and affect liver damage, so ensuring that a patient’s liver is functioning at a normal level is incredibly important before starting them on a PPI. 

    I would explain to CF that there are possible adverse drug reactions that we would watch for. PPI’s can put the patient at risk for interactions with other medications due to interrupting the drug absorption so we would go over his mediation list (Woo et al., 2020). There is also a risk for vitamin deficiencies so ensuring that he is eating a healthy diet full of fruits and vegetables would be necessary (Woo et al, 2020). CF is also at risk for pneumonia and with long term use of a PPI, osteoporosis and hip fractures especially because he works a sedentary job so, when he is not at work making sure he gets enough exercise is crucial (Woo et al., 2020). As a future APRN anytime I start a patient on a new medication I want them to understand why they are on the medication, the benefits of taking it, but to also have an understanding of the side effects and adverse effects.  

What counseling points about this medication do you give CF?

   There are a few counseling points about this medication that I would explain to CF. First, I would explain that I would start CF on a daily dose of a PPI. I would start him on a daily dose and then if symptoms are not resolving or only slightly better than we can increase to twice daily (Woo et al., 2020). Secondly, I would explain that it is important for CF to take this medication daily before breakfast (Fass, 2021). This will help reduce acid before eating and if he takes a second dose it would be important to take this dose before dinner. I would then explain that it is important for CF to be medication compliant. Last, I would tell CF about possible side effects of PPI’s which can include diarrhea, nausea, vomiting, and rebound heart burn if CF stops the PPI abruptly (Ambizas, 2017). I would counsel CF to report these side effects to me if they occur. 

post 2

1. What lifestyle modifications do you recommend for CF?
Lifestyle modifications would include no food or drink before bed, continued smoking cessation, dietary changes and elevation of the bed (Woo & Robinson, 2020). Dietary changes should include stopping foods that can potentially aggravate reflux symptoms including caffeine, coffee, chocolate, spicy foods, highly acidic foods such as oranges and tomatoes, and foods with high fat content (Katz et al., 2013). The role of alcohol with GERD is still controversial with some reports suggesting alcohol weakens the esophageal motility and reduces pressure of lower esophageal sphincter while other studies finding no relation of alcohol and risk of reflux (Pan et al., 2019).  
2. Describe a rational drug choice for this patient.
The drug choice for this patient after lifestyle modification would be a proton pump inhibitor or a PPI. This patient has tried over the counter antacids with minimal effect and for this reason PPIs are the first line treatment that is recommended (Woo & Robinson, 2020). Symptom history of regurgitation and heartburn are the most reliable for making a diagnosis based on history alone (Katz et al., 2013). Signs and symptoms include burning substernal pain that radiates upward that can be increased after meals and laying down, sore throat, hoarseness, halitosis and halitosis (Woo & Robinson, 2020). The patient has a diagnosis of GERD by endoscopy and his symptoms correlate with this diagnosis. Proton pump inhibitors decrease the acid secretion by 100% by binding to the enzyme hydrogen, potassium ATPase (Woo & Robinson, 2020). Patients with hepatic impairment may need lower doses of PPI (Woo & Robinson, 2020). PPIs also interact with warfarin, phenytoin, diazepam, and clopidogrel (Woo & Robinson, 2020). Other side effects include diarrhea, stomach pain, headache and potential interference with food and minerals (H2 blockers & PPI, 2019). There are also long term effects to consider like reduced Calcium absorbtion, decreased Magnesium and rebound gastric secretions (H2blocker & PPI, 2019).  
3. What counseling points about this medication do you give CF?
CF would be counseled on how to take the drug and on the importance of assessing the symptoms after 4 weeks of therapy and if there is no improvement the patient need to know that they will be referred to a specialist (Woo & Robinson, 2020). CF will also be counseled about the importance of lifestyle modifications and the importance and side effects of the drug.

use APA format and 3 or more reference.

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by Including your rationales in your explanation.

Response to 2 Peers

1. Consider your peer responses.  Are they similar or different than yours?

2. How do other’s perspectives on ethical considerations impact your view?

**When I accept the bid I will be sending you the two peer posting which to respond to. Please use their name at least twice but not excessively. Do not compare the two peers with each other only compare their individual post with mines. 250 words each with two references each, the references are not included in the word count. 

MY POST:

How often do healthcare providers encounter ethical dilemmas in end of life care?

            Medical practitioners come across moral dilemmas more frequently in their professional careers and practice (Odgers, 2019). In these situations, the no-correct response is stark evidence. This is particularly true in end-of-life treatment, where clients and families may be dealing with intense feelings, sadness, and tragedy.

What is the source of the ethical dilemma?

Communication problems, clinical confidentiality being harmed, inadequate treatment control, non-beneficial treatment, and joint decision-making can all lead to ethical dilemmas. Communication is a key model in the moral quagmire (Liu, 2017). It affects how patients perceive information about the prevailing health conditions.

What is the nurse’s role in this situation?

Immunology clinicians can help patients, close relatives, and guardians overcome ethical dilemmas by providing the best quality treatment while helping them to encounter EOL with integrity (Liu, 2017). Nurses can keep the patients in terms of the current health status while offering solace and guidance.

What legal and ethical standards must health care personnel be expected to consider in end of life care?

The medical personnel should provide full information to the patients. Another standard is confidentiality where the clinical person should disclose the details to the patient only.

The information on the health of the patient can only be disseminated to other parties with his or her consent (Tahan, 2020). Another standard is disclosure. The patient should be briefed on all matters concerns his or her health.

If you did not agree with the decision being made, can you excuse yourself from caring for the patient?

The medical practitioner can express dissatisfaction with the exercise. This can be contained in the fact that an incorrect decision may be made (Croxon, 2018). The clinical expert can decide to part ways with the therapy for it may result in a negative outcome.

Ultimately, who should make a decision about end of life care? Explain your rationale.

The patient can make a judgment about the end of life care. This is because they are the consumers of health products and dictate their preferences (Tahan, 2020). In the case, the patient feels incapable of continuing with the therapy they can request termination. The medical personnel is bound to offer guidance and facilitate the process.

Provide (2) 150 words substantive response with a minimum of 1 APA references for RESPONSES 1 AND 2 below. Response provided should further discuss the subject or provide more insight. To further understand the response, below is the discussion post that’s discusses the responses. 100% original work and not plagiarized. Must meet deadline.

RESPONSE 1:

Cyber warfare is action of utilizing cyber technology to damage or cause harm to another nation state or country. Cyber warfare targets mostly states and governments that are operating across wide networks and nations around the world. Example could be government installation that is creating projects for nuclear weapons or new technology. The types of cyber weapons go from just Trojan horse to something much stronger and complex such as Trojan horse, SQL injections, DDoS attacks, backdoors, and many more attacks. The weapons and cyber attacks variety in many different platforms and code utilization. Examples is attacker could create stealth scanner with python program instead of net-cat program to avoid being caught. The weapons depend on complexity of programmers knowledge and understanding of making cyberweapon. Defensive measures can variety from major too large for organization such as using firewall, IPS or IDS, Packet sniffer, Whitelist or blacklist In organizations inner layer of network. The future of cyber warfare is going to continue to grow as technology advances and will become much complex than where it’s currently at right now. We have seen major spike in cyber attacks with 2020 and 2021 but it just won’t stop with advancement in technology.

-MICHAEL

RESPONSE 2:

Cyber warfare involves an attack on a nation’s cyber critical infrastructure by an adversary. A cyber attack that is categorized as cyber warfare might target a nation’s electrical grid, fuel supply, financial institutions, agriculture, or military resources. The purpose of cyber warfare is to effect as much damage as possible in an effort to weaken an adversary nation in terms of their resources and in terms of the faith of the populace in their government. The types of weapons and tactics an intruder might use are quite diffuse. Recently, we have seen the deployment of ransomware malicious software that requires the transfer of funds from the victim to the cyber-criminal in order for the victim to regain access to their own cyber infrastructure. We have also seen many highly publicized zero-day exploits, such as the cyber attacks that targeted US government agencies via the Microsoft outlook exchange. Throughout the length of this course, we have often learned that often the best defense is continued education and training provided to employees so that they do not fall victim to a cyber scam that has the potential to widely impact a cyber network. In addition to educating the workforce regarding the dangers of malicious software and all the ways in which it can be deployed, regular scans of networks associated with cyber critical infrastructure can determine any abnormalities that might be indicative of a cyber-attack. In the future, cyber warfare attacks will undoubtedly be more prevalent. Cyber-attacks are inexpensive and hard to attribute to a particular cyber action or nation state, making it the perfect way to conduct an attack while maintaining plausible deniability. The current administration’s focus on cyber security is crucial for safeguarding out networks in the future.

-LAUREN

In this writing assignment, you will evaluate a contemporary moral issue in relation to moral theories, a specific moral system, and a personal moral system.

Step 1: Conduct research and select a news story.
Throughout your studies, you have been exposed to many moral theories. You have probably agreed with some and disagreed with others. In this assignment, you have the opportunity to explore some of these theories more fully by applying the theories to a contemporary issue.

Using the Internet, select a recent news story that involves a contemporary moral issue. Examples might include, but are not limited to:

• Capital punishment
• Abortion
• Euthanasia
• Mercy killing
• Affirmative action
• Cloning

Conduct further Internet research to identify three differing proposed solutions or positions related to the news story.

Step 2: Write an 800+ word essay. In your essay, complete these tasks:

• Summarize the news story.
• Apply the appropriate ethical theories you have studied to the three solutions/positions you identified in your research. Explain your reasoning.
• Compare possible outcomes of the solutions/positions represented by the ethical theories.
• Critique the solutions/positions in light of your personal moral system and defend your position.

Step 3: Save and submit your assignment.

When you have completed your assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor.

Cite any sources in APA format.

Competency

This competency will allow you to demonstrate the use of conflict management and negotiation strategies in decision making.

Instructions

In your role as NoJax’s organizational behavior consultant, you continue to focus on the area of conflict management. NoJax currently has some constraints within their structure that have the potential to create conflict and lacks the necessary relationship-based structure to handle them. To address or avoid conflict, some strategies and processes will need to be implemented.

You will need to consider the information presented in the company background document

and information within the module to conduct your conflict management assessment. Identify potential areas of conflict within the management structure and organizational constraints that may be affecting decision making. Address the following in your report:

• What do you perceive to be constraints in the structure that may hinder effective decision making and why?
• Using the decision-making process, identify and explain ways NoJax can make decisions more effectively.
• How can the elements and techniques of negotiation be used to reduce potential conflict with employees?
• Identify and explain the steps in conflict management that NoJax should use to address issues that they may encounter.

Grading Rubric

FFCBA01234No PassNo PassCompetenceProficiencyMasteryNot SubmittedNo identification of constraints within structure that may hinder effective decision making.Identified constraints within structure that may hinder effective decision making but offers no explanation of why.Identified constraints within structure that may hinder effective decision making and offers an incomplete or inaccurate explanation of why.Identified constraints within structure that may hinder effective decision making and offers a complete and accurate explanation of whyNot SubmittedNo identification of the steps in decision making or how NoJax should address issues that they may encounter.Identified 2-3 of the decision making elements and explained how they can be used to make decisions more effectively.Identified 4-5 of the decision making elements and explained how they can be used to make decisions more effectively..Identified all 6 of the decision making elements and explained how they can be used to make decisions more effectively.Not SubmittedIdentified some of the elements and techniques of negotiation, but provided no explanation of how they can be used to reduce potential conflict.Identified 2-3 elements and techniques of negotiation and explained how they can be used to reduce potential conflict.Identified 4 elements and techniques of negotiation and explained how they can be used to reduce potential conflict.Identified all 5 of the elements and techniques of negotiation and explained how they can be used to reduce potential conflict.Not SubmittedNo identification of the steps in conflict management or how NoJax should address issues that they may encounter.Identified 1 of the steps in conflict management and explained how NoJax should address issues that they may encounter.Identified 2-3 of the steps in conflict management but didn’t completely explained how NoJax should address issues that they may encounter.Identified all 4 of the steps in conflict management and completely explained how NoJax should address issues that they may encounter..